3.2 Antecubital Fossa

Question 1

Describe the boundaries of ACF

Answer 1

Medial:
Pronator teres (Lateral) 

Lateral:
Brachioradialis (medial)

Superior:
Horizontal line connecting epicondyle
medial and lateral

Roof:
Sin superficial and deep fascia
Bicipital aponeurosis

Floor:
Brachialis + Supinator
overlying capsule of joint

Question 2

Nerves:

Answer 2

1. Ulnar
   (medial cord of BP)
   Enters fossa medial to Brachial A.
2. Lateral Cutaneous of forearm
   (Musulocut)
   Radial border
3. Medial Cutaneous
   (med cord BP)
   Ulnar border

4. Median
Medial to brachial A
artic branch to join
Exits over Pronator Teres
Giving off anterior IO nerve

5. Radial
   Radial border

between B’Radilais + brachialis
Not consistently in fossa

Question 3

Arteries

Answer 3

1. Brachial Artery
   Enters between Median N
   Biceps tendon

Deep to bicipital aponeurosis

Bifurcates at apex:
form superficial radial
and deeper Ulnar

Question 4

Veins:

Answer 4

1. Cephalic:
Ascends along radial aspect forearm
Crosses in roof fossa
ascends arm lateral biceps
deltopectoral groove
Pierces fascia
Joins Ax Vein

2. Basilic V
   Ascends medial aspect forearm
   Crosses roof of fossa
   medial to biceps

in middle arm
Pieces biceps fascia
Joins brachial V to form Ax vein

3. Median Cubital V
Connects cephalic and basilic V
across cubital fossa
Crosses brachial artery
Separated by deep fascia

Question 5

Indications for vessel cannulation

Answer 5

Diagnostic
Venepuncture - admin contrast during imaging procedures

Therapeutic:
Insertion IV cacnnula
Elective / emergency procedures
Admin GA or Drug infusion

Aterial or VBG sampling

IABP

Peripheral long lines
PICC / Drum cathter LT abx admin
feeding
assess CVP

Question 6

Complications from cannulation of vessels

Answer 6

Immediate:

1. Infiltration
   Incorrect position of needle or cannula tip
   outside lumen vessel
2. Extravasation
   Admin of fluid/drug
   adjacent tissue
   possible injury
3. Air embolization
4. Incorrect vessel cannulated
   -A not V
   Intraarterial injection possibility
5. Nerve injury
   common during A line
   proximity median N and brachial A
6. Critical ischaemia to distal forearm

Brachial Artery - end artery
complete occlusion
dissection / thrombus d/t line insertion

Question 7

Late

Answer 7

Infection
Aseptic insertion
reduces bacteraemia in hosp patient

superficial infection and subsequent bacteraemia

Vis Inf Phlebitis
Scores routine assess
Recommendation cannula in situ <3 days

Thrombophlebitis